> One legitimate question seems to be "Does it happen often enough and does
> it cause enough long term effects to justify finger feeding or cup
> feeding for EVERY baby that must receive EBM or ABM?"

I've always wished babies came with a little label in some discrete place
that says "I have the potential to become nipple confused." or "Either/or,
I'm OK."  It would save so much time and grief.

I truly believe in nipple confusion.  When you work with babies day in and
day out in the hospital you can become a firm  believer.  "Nipple
confusion" may be a matter of semantics.  It may be that in some places the
bottle is not quickly resorted to, but in places where the answer is always
give a bottle, it is seen quite commonly.

I agree with Jean that it is the changing characteristics of the mom's
nipple and areola that makes baby work in the first week or so and the
bottle is consistent. How many of you have seen the baby on day 3 (probably
at home) who had been nursing just fine in the hospital and is now refusing
to latch on to a fuller, hard breast/areola? (This is also nipple
confusion!)   I tell mom's that they have changed the landscape by becoming
engorged and now baby needs to learn   how to handle something different.
(and then teach all the tricks to  mom  to soften the
nipple/areola/breast.)   But just think that the mom's changing breast
teaches baby to adapt, be flexible, be creative, so this is really baby's
first bit of education and learning.

Also the 3 mo old who refuses a bottle,  is nipple confused, but is making
the "right" choice,  has become a zealot and only wants the real thing!

Whether to breastfeed one's own baby or find another way has been an age
old problem.  There have always been some women, for whatever reason, who
did not want to BF.  These sorts of problems and people are not going to go
away.  We just have to deal with them as best we can and accept their
limitations.  Sincerely, Pat in SNJ